Literature Collection

National Health Service (NHS) England highlights the need for preventative, specialist support for adults with mild eating difficulties. This evaluation explored the effectiveness of an Adult Eating Disorder Integrated Mental Health Service (AEDimhs) in reducing mild eating difficulties, within primary care. The lived experience of service users (n = 12) and staff (n = 12) was thematically analysed and levels of staff wellbeing and burnout reported. Individual service-level data (N = 363) were gathered; however, 59.6% of outcome data were Missing Not At Random and n = 69 pre-post intervention mental health outcomes were available for analysis. Statistically significant improvements were found in ED-related thoughts and actions (EDE-Q) and psychosocial difficulties (CIA), while overall distress (CORE-OM), depression (PHQ-9) and anxiety significantly reduced (GAD-7; all measures p < .001). Staff reported moderate levels of wellbeing and low burnout. Thematic analysis identified four themes: 'bridging the gap', 'empowering interventions', 'adaptability and flexibility' and 'shaping the future'. Findings suggest that AEDimhs can potentially provide effective, preventative, specialist support within primary care. Research with larger and more diverse populations is required to strengthen the evidence base and enable evaluation of long-term follow-up.

A high prevalence of mental health diagnoses in adults alongside ongoing shortages of mental health specialists and expansion of the patient-centered medical home have increased the involvement of primary care clinicians in treating mental health concerns. Using nationally representative serial cross-sectional data from the 2006-18 National Ambulatory Medical Care Surveys regarding visits to outpatient primary care physicians by patients ages eighteen and older, we sought to characterize temporal trends in primary care visits addressing a mental health concern. Based on a sample of 109,898 visits representing 3,891,233,060 weighted visits, we found that the proportion of visits that addressed mental health concerns increased from 10.7 percent of visits in 2006-07 to 15.9 percent by 2016 and 2018. Black patients were 40 percent less likely than White patients to have a mental health concern addressed during a primary care visit, and Hispanic patients were 40 percent less likely than non-Hispanic patients to have a mental health concern addressed during a primary care visit. These findings emphasize the need for payment and billing approaches (that is, value-based care models and billing codes for integrated behavioral health) as well as organizational designs and supports (that is, colocated therapy or psychiatry providers, availability of e-consultation, and longer visits) that enable primary care physicians to adequately address mental health needs.